For a member who will be absent from work for a month or more and is still considered an employee by the employer. The completed form should be sent to PERA within 90 days of the first day of the member's leave for membership rights to continue in Colorado PERA.
Complete this form to certify continuous coverage if you are enrolling based upon first Medicare eligibility, end of COBRA coverage, or loss of previous coverage. (This certification form is not required if you are enrolling at retirement or during an open enrollment period.)
To be completed by the employer when they are able to accurately certify the final salary payment on a deceased member's account. This form also certifies the member's employment status at the time of death. This form is mailed to the employer by PERA when we are notified of a member's death or the employer may use the form as notification to PERA of an employee's death.
Complete this form if you are a rural school district employer and wish to designate a PERA retiree as a critical shortage retiree, exempting the retiree from the PERA working after retirement limits.
This form must be submitted by PERA employers who are eligible to designate 10 retirees to work over the regular working after retirement limit pursuant to C.R.S. 24-51-1101(1.8).
